The burned and collapsed remains of the medical storage structure lie before other destroyed buildings at the MSF hospital in Leer, South Sudan, February 23, 2014.

July 01, 2014

Large parts of South Sudan have been engulfed in conflict for the past six months. On December 15, 2013, violence broke out amongst security forces in the capital Juba, following longstanding political tensions within the ruling party.

As security forces split largely along ethnic lines, fighting between forces loyal to President Salva Kiir and forces loyal to former Vice President Riek Machar quickly spread into Jonglei, Unity, and Upper Nile states.

To date approximately 1.5 million people have fled their homes, with over one million displaced inside South Sudan, and 378,000 seeking refuge in Ethiopia, Kenya, Sudan, and Uganda. Inside South Sudan, internally displaced people (IDPs) are living in camps or the open air. Those in IDP camps include an estimated 94,000 people living in Protection of Civilian (PoC) sites inside the United Nations Mission in South Sudan (UNMISS) bases across the country. (When the conflict started, UNMISS allowed tens of thousands of people to take refuge in its bases; protection of civilians inside UN compounds on this scale was unprecedented in UN history.)

In many areas camps are dangerously overcrowded and suffer inadequate water and sanitation. Such conditions heighten tensions and bring increased risks of epidemics. Those living in the open, without adequate food, clean water, or shelter are also extremely vulnerable to malnutrition and outbreaks of diseases such as malaria. The conflict has seen disturbing trends of violence and brutality. This has included large-scale killings of civilians and targeting of people based on their ethnicities and perceived political allegiances—including in Juba, Bor, Malakal, and Bentiu. In other areas, entire towns, such as Leer in Unity state, have been destroyed.

One particularly stark aspect of the conflict has been violence against health care. Patients have been shot in their beds, medical and humanitarian staff has been killed, and hospitals, ambulances, and medical equipment have been burnt, looted, and otherwise destroyed.

Hospitals and places meant to shelter civilians from hostilities are specifically protected under International Humanitarian Law (IHL). These rules have been violated repeatedly throughout the current conflict in South Sudan. An already fragile health care system has been destroyed in areas affected by conflict and largely neglected in other areas, leaving hundreds of thousands of people without medical care at a time when it is critically needed.

Doctors Without Borders/Médecins Sans Frontières (MSF) has repeatedly condemned such violence against health care facilities, patients, and staff. Such incidents have greatly affected its ability to deliver humanitarian assistance to vulnerable people.

With this briefing paper, MSF seeks to bring into focus the impact of persistent violence on medical activities since December 15, 2013. The information presented is far from exhaustive, and only highlights those incidents of which MSF has direct or verifiable knowledge. It is important to note that many incidents that deny the wounded and sick access to health care go unreported; this is particularly the case in rural areas.

Moreover, while this briefing paper focuses on violence against health care in the past six months, attacks against medical care are not new in South Sudan. Throughout its 30-year history in the country, MSF—as well as other humanitarian organizations and health care providers—has repeatedly witnessed violence against staff, patients, vehicles, compounds, and health care facilities. What has been particularly alarming in the current conflict, however, has been the scale and breadth of the violence.